Childbirth is a complex, subjective phenomenon, the significance of which is influenced by sociocultural and individual factors. Anxieties surrounding childbirth, often stemming from gaps in knowledge about the physiological process, can negatively affect maternal expectations. Prenatal health education has been proposed as a key intervention to mitigate these anxieties by enhancing self-efficacy, promoting patient autonomy, and encouraging active participation.
ObjectiveThis study aimed to investigate women's perceptions of their labor and childbirth experience following participation in a patient-centered prenatal education program, the 'Oficina do Parto'.
MethodsThis qualitative study used thematic analysis. Participants included nine women and their companions who attended the 'Oficina do Parto' program. Data were collected through semi-structured interviews conducted during the postpartum period.
ResultsThe analysis yielded two main themes: 1) the perceived impact of the educational program on labor and delivery experiences; and 2) the role and influence of the companion's participation during childbirth. Participants reported that the program effectively increased their knowledge, which contributed to a more positive childbirth experience and a greater appreciation for the companion's role.
ConclusionThe 'Oficina do Parto' program successfully enhanced women's knowledge, fostering positive perceptions of childbirth and the involvement of companions. The alignment between the educational content and the practices of the attending obstetric team, together with the women's prior childbirth knowledge, emerged as factors that positively influenced the overall childbirth experience.
Childbirth is a multifaceted, subjective phenomenon whose meaning is shaped by an individual’s sociocultural context and personal experiences.1 The World Health Organization (WHO) defines a positive birth experience as one that “meets or exceeds the woman’s prior personal and sociocultural beliefs and expectations, including giving birth to a healthy baby in a clinically and psychologically safe environment, with continued practical and emotional support from birth companion(s) and a caring and technically competent clinical team”.2
The possibility of experiencing pain and fear can influence pregnant women’s expectations of childbirth3,4 and their choice of delivery method, contributing to higher cesarean rates.5,6 Between one-third and one-half of women report a positive birth experience, while 20–50% report a negative or traumatic experience.7 Negative experiences often involve disrespect, lack of empathy, or inadequate care from healthcare professionals during labor and birth.8 Some women also report concerns stemming from insufficient knowledge about childbirth.9 Such experiences have been linked to breastfeeding difficulties, post-traumatic stress, and postpartum depression.10–12
Prenatal health education regarding labor and birth can enhance women’s sense of safety, reduce anxiety, minimize the use of pain medication and obstetric interventions, and assist with the transition to parenthood.13 According to Brazilian pregnant women's perceptions, barriers to prenatal care include difficulties with initial contact at primary healthcare units, shortened consultation times, excessive bureaucracy, and the lack of health education initiatives.14
Health education is a strategy that exchanges information between healthcare professionals and patients through dialogue, enhancing knowledge, fostering autonomy, and promoting active participation.15 For pregnant women, it includes guidance on labor stages, body positions and exercises to facilitate fetal descent, and breathing and relaxation techniques,16 aiming to support a positive birth experience. In this context, a Brazilian physical therapist specialized in Women’s Health developed the Oficina do Parto: Educação em Saúde para Casais Grávidos (Childbirth Workshop: Health Education for Pregnant Couples), a patient-centered program designed to prepare expectant couples, address prior knowledge and concerns, and encourage active participation. Through active learning, the workshop prompts couples to share and discuss their knowledge, which is then expanded with evidence-based information, fostering engagement in achieving the desired birth experience.17
Health education strategies are highly relevant and transformative.18 A phenomenological perspective, which captures individuals’ lived experiences—both what and how they were experienced19— can help understand the influence of the Oficina do Parto on women’s perceptions of childbirth. Growing evidence also supports information on labor and delivery in prenatal programs. This study therefore aimed to explore women’s perceptions of labor and childbirth after participating in the Oficina do Parto.
MethodsThis qualitative study is part of a larger research project on prenatal education and fear of birth, approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais (UFMG) (CAAE: 67438323.70000.5149). The study followed the guidelines of the Consolidated Criteria for Reporting Qualitative Studies (COREQ)20 and the Standards for Reporting Qualitative Research (SRQR).21 Phenomenology served as the methodological framework. It followed the principles of Edmund Husserl, who defined it as the science of phenomena that investigates what appears to consciousness and how it is experienced in all its possible meanings.22
ParticipantsParticipants were selected through convenience sampling, as they were users of the Women's Health Physical Therapy Service at the Jenny de Andrade Faria Outpatient Clinic, Hospital das Clínicas of the Universidade Federal de Minas Gerais (HC/UFMG), or of the Women's Physical Therapy Laboratory of the Escola de Educação Física, Fisioterapia e Terapia Ocupacional of UFMG (LAFIM/UFMG). They were personally invited to participate in the study.
The study included women who were 18 years or older, had a gestational age of 35 weeks or more, were literate, had internet access, and had a companion willing and available to participate in the Oficina do Parto. Women with obstetric complications during pregnancy, such as placenta previa, premature placental abruption, eclampsia or preeclampsia, or fetal anomalies, were excluded. All participants who agreed to take part provided written informed consent. Data were collected between September 2023 and January 2024.
InterventionThe first stage of this study involved collecting sociodemographic and clinical data using a questionnaire developed specifically for this research. It also included the implementation of the Oficina do Parto, which was conducted in person at HC/UFMG and LAFIM/UFMG, by the lead researcher, a physical therapist specialized in women’s health with experience in prenatal care and labor support. Each pregnant woman and her companion attended a single session.
In line with the Oficina do Parto methodology, cards containing pre-established content or material generated based on the knowledge and needs of each pregnant woman and her companion were provided. These cards included keywords and/or expressions reflecting common knowledge about labor and childbirth (Table 1).
Keywords and/or expressions related to labor and birth printed on the cards used in the Oficina do Parto.
Source: Oficina do Parto: educação em saúde para casais grávidos / Elza Lúcia Baracho Lotti de Souza et al. - 1. ed. - Rio de Janeiro: Medbook, 2021. Page 33.
For 10 min, without the physical therapist’s involvement, the pregnant woman and her companion arranged the cards in chronological order based on their prior knowledge of labor and childbirth. The physical therapist then invited them to present their sequence, encouraged participation, and addressed questions. This was followed by a practice session in which they experienced non-pharmacological pain-relief techniques, pelvic mobility exercises, and positions for the expulsion phase (Fig. 1a and 1b). Tools such as a Swiss ball, peanut ball, and wall bars facilitated posture variation. Women were also encouraged to regularly change positions during labor to identify those providing the greatest comfort and effectiveness (Supplementary Material).
Semi-structured interviews
The second stage, conducted 40 days postpartum, involved semi-structured interviews guided by six open-ended questions. Interviews were conducted online via Microsoft Teams, audio-recorded, transcribed verbatim, and returned to participants for feedback. Two trained undergraduate physical therapy students from UFMG conducted the interviews, encouraging participants to elaborate through follow-up questions until all items were addressed. A pilot interview with one participant indicated no adjustments to the script were needed.
Data analysisData were collected, stored, and organized to ensure confidentiality and accuracy. Descriptive analyses of sociodemographic and clinical data were presented as means and standard deviations for continuous variables and as frequencies and percentages for categorical variables.
Deductive content analysis was used to analyze the qualitative data, with thematic categories serving as the units of analysis. The analysis was conducted in three main phases: (1) pre-analysis, (2) material exploration, and (3) treatment of results.23,24
During the pre-analysis phase, the interviews were initially reviewed by the researchers (J.C.C., M.T.P.A., and M.M.O.S.) using floating reading to obtain an overall understanding of the material. Indicators were then developed to guide the final interpretation, such as identifying references to specific themes within participants’ narratives. In the exploration phase, relevant units of meaning were extracted from the transcripts and organized into thematic categories. In the results processing phase, data were analyzed through inference and in-depth interpretation, and the findings were articulated in relation to the theoretical framework.23,24
ReflexivityTo conduct the interviews, two undergraduate physical therapy students (T.H.S.S. and M.L.O.S.) were trained by a senior physical therapist (J.C.C.) with experience in conducting the Oficina do Parto. Prior to the study, some participants were already familiar with the interviewers, as they had previously received care from them through Women’s Health physical therapy services at UFMG. All participants were informed about the purpose of the study and the researchers’ interest in the topic.
After analyzing the interview data and identifying recurring patterns, themes, and subthemes, the researchers concluded that no new information was emerging, and that additional data collection was unnecessary.
ResultsNine participants were interviewed, with an average duration of 15 min per interview. No postpartum woman refused to participate. The average age of participants was 32 ± 5.9 years, and the average gestational age was 36.89 ± 1.36 weeks. Six participants had been accompanied by a physical therapist specializing in Women's Health throughout their pregnancy (Table 2). Eight participants had their husbands as companions during labor and childbirth. To ensure anonymity, each participant was assigned an alphanumeric code (P1 to P9) based on the order of the interviews.
Sociodemographic and obstetric characteristics of the participants (n = 9).
After the thematic analysis of the interviews, two relevant thematic categories with subthemes were identified (Fig. 2).
The first thematic category relates to the perception of the pregnant women regarding the contribution of the Oficina do Parto in labor and childbirth, making it possible to identify two subthemes: the knowledge and the practice of guidelines during labor and delivery; and the barriers and facilitators for implementing guidelines received in the Oficina do Parto.
During the analysis of the interviews, it was observed that the recognition of labor stages as provided during the Oficina do Parto directly impacted the pregnant women’s confidence, security, and autonomy: “(...) I understood the stages of labor thanks to the help and what I had already sought (...). So, I arrived at the hospital with 4 cm of dilation. It progressed very quickly to 7 cm without analgesia, without anything, so I was fine... I was understanding the stages, so that made me very confident, very secure.” (P6) “(...) then I remembered you all saying: oh, every 10 min, three contractions. So, when I started feeling them, I didn’t call the doctor, nurse, or anyone, I started timing... I thought it was cool, because I knew what to do.” (P5)
Furthermore, the protagonism of the laboring woman was favored and influenced by her understanding of the benefits of certain postures during labor, as practiced during the Oficina do Parto. This finding is evident in the statements of P4 and P5, pointing to a positive aspect of the Oficina do Parto: “(...) I spent most of my labor on the ball... doing exercises, so maybe that helped a lot. I also used the support bars, you know... to do some exercises, ... and yes, it helped, even the expulsion position itself” (P4) “The obstetrician told me: you’re 7 cm dilated, walking helps. I already knew these things, so I said to her: don't worry, doctor, and then I started walking.” (P5)
Other non-pharmacological pain relief measures, such as breathing and vocalization techniques, as well as guidelines on showering and warm compresses, were addressed in the Oficina do Parto and applied by the women: “(...) I went to the shower, and then he massaged me, did the things you suggested...” (P1). “Breathing techniques, managing the contractions and knowing the right moment to push... it helped me feel prepared, because I didn’t know any of this, you know?” (P7). “(...) it was really painful... I needed to vocalize, make that sound, you know, open my mouth and make: aaaaaaaaaa, to see if it helped relieve the pain a bit” (P2).
However, one participant expressed that the breathing method did not provide the expected relief: “(...) I tried breathing, doing the breathing exercises, but when the contraction came, the pain was too strong, you know... it was a different kind of pain...” (P9).
Regarding subtheme two, the identification of barriers and facilitators to applying the guidelines learned and practiced during the Oficina do Parto provided a deeper understanding of the personal and environmental factors that influenced the women's adherence to these guidelines. A lack of encouragement from the health team to use the available resources in the maternity ward and family-related issues were some of the barriers identified: “(...) I had already entered the active phase, so I was in the hallway, without access to the ball, the bars to hold on to, you know? ...I was just in the hallway.” (P3) “(...) one of the teams that assisted me wasn’t providing the necessary care nor answering my questions” (P8). “My problem was that my mother-in-law was here, at home... I was holding back labor. That was a big difficulty... I started having contractions and pretended to be dead. I didn’t tell anyone, only my husband and my mother knew. Emotionally, I wouldn’t let the process move forward...” (P1).
Regarding facilitators, it was observed that the women’s engagement in activities prior to the Oficina do Parto and their previous birth experiences contributed to the successful implementation of the guidelines received during the Oficina do Parto. Additionally, appropriate support provided by the healthcare team during labor and delivery was identified as a key facilitator for this process: “Yes, I was fine, really confident, really secure. I already had two experiences, you know? ... I already had a lot of information, I was well-prepared” (P1). “(...) because with my first child, I had already studied a lot. (P2). “(...) I already had a lot of information, but going through a physical therapist reinforced all the information. I had all the guidelines and I think it also helped me feel more confident, you know?” (P2). “(...) people gave me a lot of confidence (...) with the obstetrician, who explained everything that was happening with me, what I could and couldn’t do” (P5). “(...) the medical team made me feel very comfortable with how I wanted to give birth. They applied massages during the delivery, talked about everything, played the music I wanted to hear. The delivery room had different lighting, which gave a sense of comfort.” (P6).
Theme two – experiences of the postpartum women regarding the participation of the companion during labor and delivery – refers to feelings and emotions experienced by the participants in relation to their partnership. The emotional support provided by the companion and the applicability of the knowledge gained in the Oficina do Parto impacted the behavior and security of the laboring woman during labor and delivery: “It was super important, because I felt safe with him close, and he understood the whole process of labor, you know?” (P1). “He would hold me, we would get up, do the exercises you taught us that day, I didn’t remember, but he did...” (P5). “He emotionally, mentally, gave me the strength to continue with the delivery, to go all the way to the end.” (P8). “My husband stayed with me the whole time. For sure, I think it was essential, because he was a point of security for me, you know?” (P2). “It was essential, without him, maybe I would have given up on the vaginal delivery, which is what I wanted, you know?” (P4).
Educational practices are effective strategies for promoting women’s protagonism in the obstetric setting.25 In this study, they appeared to enhance women’s understanding of pregnancy and childbirth, particularly in recognizing warning signs, the onset of labor, and its stages — essential elements of prenatal care. Despite their importance, pregnant women often experience difficulties in identifying these aspects, which can delay timely decisions about seeking care.18 In this context, participation in the Oficina do Parto, led by a trained physical therapist, seemed to expand prior knowledge and foster greater awareness, confidence, and autonomy during labor and childbirth.
Women’s prior knowledge about labor and childbirth may come from previous experiences, shared experiences with other women, educational materials, or prenatal visits.26 However, this knowledge does not always lead to a positive childbirth experience. In this context, the Oficina do Parto serves as a key educational strategy, helping women reframe prior knowledge and gain practical guidance. Analysis of postpartum narratives showed that the Oficina do Parto pain-relief strategies increased confidence and helped women recognize labor stages, highlighting the role of non-pharmacological approaches in coping with labor pain. Systematic reviews similarly indicate that showers, immersion baths, and massage can reduce the need for pharmacological analgesia, with massage particularly effective during cervical dilation.27
Fear of contraction pain is one of the most commonly reported concerns during pregnancy,28 emphasizing the need to prioritize non-pharmacological strategies in prenatal education.29 The use of a Swiss ball has been associated with pain reduction, lower cesarean rates, decreased vulvar edema, and better management of maternal anxiety and fatigue.30 In this study, participation in the Oficina do Parto also appeared to enhance women’s understanding of pelvic biomechanics and the use of different postures throughout labor, supporting more active and empowered engagement in the childbirth process.
Breathing techniques may support a more active role and greater autonomy for women in managing labor pain, particularly when combined with muscle relaxation strategies.²⁹ Vocalization, as reported by participant P2, has been associated with reduced maternal fatigue and improved relaxation and concentration during uterine contractions.27,31,32 However, labor pain is influenced not only by physiological factors but also by cultural expectations, emotional support, environmental conditions, and women’s perceptions of their coping ability.33 In this context, women’s narratives indicate that pain-relief strategies such as breathing techniques are not uniformly effective, as illustrated by participant P9. These findings highlight the need for interprofessional approaches to provide comprehensive support for labor pain management.
Regarding the benefits of adopting specific positions during labor, evidence indicates that the use of upright positions, and the gravity effect combined with walking may facilitate pelvic mobility, contributing to a more efficient labor process with shorter duration. This approach may support internal fetal rotation and cervical dilation,34–38 as well as increase pelvic diameters, enhance uterine contractions, and reduce maternal and fetal complication rates.39
It is noteworthy that, in Brazil, the Ministry of Health Ordinance No. 1153 (May 22, 2014) requires public and private facilities to provide labor pain-management resources, including bathtubs, showers, massagers, Swiss balls, and warm or cold compresses. Limited access to these resources, combined with insufficient professional support, hindered the implementation of guidance from the Oficina do Parto, as reported by participant P3. Similar barriers have been documented in the literature, with women expressing dissatisfaction with care and lack of professional support.40 Inadequate assistance can negatively affect childbirth experiences, and disregarding women’s concerns may generate insecurity and a sense of abandonment.41 Moreover, one participant noted that some barriers extended beyond the intervention. Biopsychosocial changes during pregnancy can affect mood and well-being,40 which are influenced by individual and contextual factors such as family dynamics, as illustrated by participant P1. These findings suggest that educational practices should also address broader contextual and family influences.
The comparison between primiparous and multiparous women suggests that previous birth experiences may enhance confidence and perceived control during subsequent deliveries.42 This was reflected in the statements of participants P1 and P2, who described prior experiences as positive because they contributed to knowledge, understanding, and familiarity with the labor process.
The Ministry of Health also recommends prenatal care by a multidisciplinary team to provide specialized, evidence-based guidance that refines prior knowledge and promotes a safer, more satisfying birth experience.43 In this study, support from the birth team enhanced women’s satisfaction and sense of security, as reported by participants P5 and P6. Similar qualitative studies link women’s satisfaction not only to the guidance received but also to the support provided during its implementation.39
Regarding Theme 2, one of the goals of the Oficina do Parto is to encourage the active involvement of the companion. In this study, all participants reported experiencing such involvement. The World Health Organization recommends that women have a companion of their choice during labor and delivery to improve obstetric outcomes and satisfaction with care.44 Therefore, including the companion in the Oficina do Parto methodology is fundamental for promoting women’s protagonism and strengthening the bond between the woman and her companion. Participant narratives indicate that companion participation influenced not only physical aspects of labor but also fostered feelings of security, encouragement, and collaboration, providing emotional support and enhancing autonomy and protagonism.
Limitations of the studyMost participants were accompanied by a Women's Health physical therapist during pregnancy, potentially exposing them to broader information about labor and delivery. However, their narratives reflected the content and guidance provided in the Childbirth Workshop, reinforcing the relevance of the study's findings and the intervention's contribution to women's understanding and autonomy regarding childbirth.
ConclusionThe Oficina do Parto facilitated the expansion of knowledge and the development of practical skills for the women in this study, promoting active participation in the labor and childbirth process. Facilitators for implementing the guidelines practiced during the Oficina do Parto included prior knowledge, previous birth experience, and appropriate support from the healthcare team. The barriers identified by the women included a lack of encouragement to utilize available resources in the maternity ward and inadequate assistance from the healthcare team. The active participation of the companion not only contributes to the physical aspects but also to emotional support, offering comfort and encouraging women's autonomy throughout the childbirth process.
One of the authors of the article, Elyonara Mello Figueiredo, is the writer of the reference book 15, Oficina do Parto: Educação em Saúde para Casais Grávidos/ Elza Lúcia Baracho Lotti de Souza ... [et al.]- 1st edition, Rio de Janeiro: Medbook, 2021, 56 p.
This work was supported by CAPES - Coordination for the Improvement of Higher Education Personnel.
